NPIMap

Organization Active NPI

H Reza a Dental Corporation

  • General Practice Dentistry
  • Northridge, CA
National Provider Identifier
1659309300
Registry record updated Oct 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
41307 Issued in CA
Legal business name
H REZA A DENTAL CORPORATION
Practice address
8540 Reseda Blvd. Ste # 101
Northridge, CA 91324
Phone
(818) 701-6667
Fax
(818) 701-0418
NPI assigned
Jun 30, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Hamid Reza Reza, D.M.DNPI 1801827001
Title
Owner.
Phone
(818) 701-6667

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 41307 CA Primary

Addresses

Primary practice location

8540 Reseda Blvd. Ste # 101
Northridge, CA 91324

Mailing address

8540 Reseda Blvd. Ste # 101
Northridge, CA 91324
Phone (818) 701-6667

Other identifiers 1

IdentifierTypeStateIssuer
B41307-02OtherCADENTI-CAL

Other names 1

  • H Reza Shahmohammadi A Dental Corporation Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20251114002242 CA Part B Supplier - Clinic/Group Practice 2668963992 Receives reassigned benefits from 1 practitioner
Practice locations: Northridge, CA; Van Nuys, CA; North Hollywood, CA

National Provider Directory

National Provider Directory
Tax ID family
H Reza a Dental Corporation4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

8540 Reseda Blvd
Ste 101
Northridge, CA 91324
Phone (818) 370-2620

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151625600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1634860800000",
    "number": "1659309300",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8540 RESEDA BLVD. STE # 101",
            "city": "NORTHRIDGE",
            "state": "CA",
            "postal_code": "91324",
            "telephone_number": "818-701-6667",
            "fax_number": "818-701-0418"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8540 RESEDA BLVD. STE # 101",
            "city": "NORTHRIDGE",
            "state": "CA",
            "postal_code": "91324",
            "telephone_number": "818-701-6667",
            "fax_number": "818-701-0418"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "H REZA A DENTAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-30",
        "last_updated": "2021-10-22",
        "certification_date": "2021-10-22",
        "status": "A",
        "authorized_official_last_name": "REZA",
        "authorized_official_first_name": "HAMID",
        "authorized_official_middle_name": "REZA",
        "authorized_official_title_or_position": "OWNER.",
        "authorized_official_telephone_number": "818-701-6667",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "D.M.D"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "41307",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTI-CAL",
            "identifier": "B41307-02",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "H Reza Shahmohammadi A Dental Corporation",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Northridge, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.